腰椎后路手术早期并发症的防治

Prevention and treatment for early complications of posterior lumbar spinal surgery

目的分析腰椎后路手术早期并发症原因,探讨其防治方法。方法回顾性调查1998～2002年收治的腰椎后路手术患者903例临床资料,男587例,女316例,平均年龄36.7岁(18～78岁),术前诊断均依据患者术前主要症状、体征及相应的影像学结果确定,根据不同诊断采用相应的手术方法治疗,对其中发生的早期并发症(术后2周内)进行统计及临床分析。结果903例中发生术后早期并发症者76例78例次(8.6%),其中2例女性患者同时出现两种并发症。主要包括神经根刺激症状(占早期并发症的64.1%),多数患者症状经对症处理,于4～30 d(平均10.1 d)得到缓解;消化道症状(11.5%),除2例给予灌肠外,其他均对症处理3～10 d(平均6.8 d)后缓解;切口深(浅)部血肿(5.1%)、脑脊液漏(5.1%)、尿潴留(3.9%)、切口深部感染(2.6%)、下肢深静脉血栓(2.6%)、肺栓塞(2.6%)、泌尿系感染(1.3%)及皮下脂肪液化(1.3%)等,所有并发症均获得良性转归。结论腰椎后路手术早期并发症影响手术疗效,除了注重术中操作外,严格掌握手术适应证,重视围手术期临床观察及处理和早期功能锻炼,将有利于腰椎后路早期手术并发症的防治。

objective To analyze the causes of early complications following posterior lumbar spinal operations and to find out about the way for prevention and treatment of those complications. Methods From 1998 to 2002, 903 patients underwent posterior lumbar spinal operations ,there were 587 males and 316 females , with an average age of 36.7years (range, 18 to 78 years ). The diagnosis of patients included lumbar disc prolapse in 483, lumbar stenosis in 145, lumbar spondylolisthesis in 96, lumbar fracture in 94, lumbar instability in 27, lumbar tuberculosis in 15 spinal tumors in 24 and reoperation in 19. All patients were evaluated by the medical history, clinical examination and review of the imaging data, and then the surgical plan was made respectively according to clinical evaluation. Results Early complications of 78 complications within 2 weeks post-operatively occurred in 76 cases with the incidence of 8.6%(78/903), in-cluding of 49 males and 27 females with an average age of 44.6 years. The complications consisted of 50 nerve root irritations(64.1%, 50/78), most of which relieved at 4 to 30 days after treatment, 9 gastrointesti-nal symptoms(11.5%, 9/78), all of which disappeared at 3 to 10 days but 2 cases needed enema, 4 hematomas of incisional wound(5.1%, 4/78), 4 cerebrospinal fluid leakages(5.1%, 4/78), 3 urinary reten-tions(3.9%, 3/78), 2 deep infections(2.6%, 2/78), 2 deep vein thrombosis(2.6%, 2/78), 2 pulmonary em-bolisms(2.6%, 2/78),1 infection of urinary tract(1.3%) and 1 fatty liquidization(1.3%, 1/78). The opera-tional procedure possible leading to surgical complication were laminectomy, nerve root dissection and in-strumentation. Conclusion Early complications may determine the clinical result of the posterior lumbar spinal operations. Besides the skilled technique, thorough pre-operative planning, close observation and proper management after operation, and early post-operative rehabilitations are of great benefit to the pre-vention and treatment of the complications.